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Nursing Practice Keywords: Objective structured clinical

examination/Formative assessment/
Discussion Summative assessment
Nurse education ●This article has been double-blind
peer reviewed

OSCEs are a useful way to assess competence at pre-registration and postgraduate

levels. Students and lecturers should be well prepared to make the most of them

The objective structured

clinical examination
In this article... 5 key
3 The NMC
OSCEs for
 hy objective structured clinical examinations are used
Checklists to assess competence 1 According to
Miller’s pyramid
of learning,
assessing student
nurses, particularly
for medicines
Practical points for students
students need to administration

Author Cathy Liddle is senior lecturer

(adult nursing and clinical skills) at
performance of clinical skills (Nursing and
Midwifery Council, 2007).
be able to “show
how” to use what
they have learnt
4 OSCEs can be
used for
Birmingham City University.
Abstract Liddle C (2014) The objective
structured clinical examination. Nursing
OSCEs are used to assess clinical skills
in both pre-registration and postgraduate
programmes (Rushforth, 2007; Major,
2 Students need
to demonstrate
competence in
(end-point) and
Times; online issue. 2005). The NMC (2007) published essential clinical skills at assessment
The objective structured clinical
examination is used increasingly in nurse
education, to assess clinical skill proficiency
skills clusters in response to the poor
acquisition of clinical skills within
nursing, and recommended using OSCEs
and postgraduate
5 Good
preparation for
OSCEs is essential
at pre-registration and postgraduate level. for assessing student nurses for medicines
Good preparation for an OSCE is vital for administration in particular.
both those running the assessments and progress (Taras, 2005; Alinier, 2003). Forma-
for students. Used effectively, OSCEs can Evidence for OSCE tive OSCEs also help to prepare students for
help students gain confidence to use their The pyramid of competence (Miller, 1990) placements, encourage them to engage
skills in their clinical work. is a framework that identifies the stages of with their learning and help them to achieve

skills students should achieve (Fig 1). In their learning outcomes (Nulty et al, 2011).
he objective structured clinical progressing up the pyramid to “shows The NMC (2010) says programme pro-
examination, first used in the how”, students demonstrate their knowl- viders for pre-registration nurse education
1970s, is an assessment of com- edge and understanding by performing in must ensure “the outcomes, competencies
petence carried out in a well- a simulated setting such as an OSCE. and proficiencies of the approved pro-
planned, structured and objective way OSCEs may be used as a summative or gramme are tested using valid and reliable
(Harden and Gleeson, 1979). It is well estab- formative assessment and on their own or assessment methods”. OSCEs assess stu-
lished within medicine and is used increas- with another form of assessment. Summa- dents’ psychomotor, cognitive and affec-
ingly in nurse education (Nulty et al, 2011). tive OSCEs are frequently used at the end of tive skills in a simulated environment and
The assessment of knowledge and skills courses or programmes, or on completion various tools score their performance.
plays an important part in student nurses’ of a module to test students against set
progression though pre-registration pro- objectives and learning outcomes. Where The OSCE environment
grammes because they need to demon- they are used as a formative assessment, the An OSCE can consist of one station where
strate competency and confidence in the feedback provided helps students to students perform one or a variety of skills
and are tested on the underpinning clin-
ical and theoretical knowledge, or mul-
Box 1. practical points for students tiple stations, each testing a different skill
or piece of underpinning knowledge
During your OSCE: something, as you may still have time to (Mitchell et al, 2009).
● Pay attention to verbal and written do it; Examples of practical skills include per-
instructions and clarify any queries with ● Keep an eye on the time; forming vital signs on a patient and using
the assessor before you start; ● Communicate with the patient/carer; an aseptic non-touch technique to per-
● Check all the equipment you will need ● On completion, take a moment to run form a simple dressing change; an assessor
is present at the station; through in your mind what you were is present during the procedure to mark
● Stay calm and focused; asked to do and check that you have each student on their skills. The underpin-
● Inform the assessor if you forget to do completed the task. ning knowledge, including anatomy and
physiology, can be assessed as a

2 Nursing Times 27.08.14 / Vol 110 Online issue /

For a Nursing Times Learning
unit on Learning and Studying
Efficiently, go to

paper-based or verbal exercise at a staffed Fig 1. the OSCE within Miller’s pyramid
or unstaffed station and marked after-
wards. Verbal questions, multiple-choice
or short-answer questions might be used. Does
OSCEs should be managed in universi-
ties’ simulated clinical skills area so all stu-
dents are exposed to the same environ-

ment (Rushforth, 2007; Major, 2005).
Scenarios, case studies or simulations are Shows How
commonly used and students are expected
to perform specific skills, interpret infor-
mation, make clinical decisions and com-
municate with patients and other team or Knows How
family members.
As students progress to a higher level of
study, the stations become more complex
(Mitchell et al, 2009; Zaidi, 2006). Unlike Knows
OSCEs in medicine, where real patients are
frequently used, nursing tends to use role
players (actors or academic staff ) or mani-
kins as the patient. The move away from to be used in the OSCE; Marking OSCEs
using OSCEs to assess skills in isolation to a » Be familiar with checklist/marking A checklist is frequently used to mark
more holistic approach where the skills are criteria; OSCEs to increase the objectivity and reli-
more integrated into the assessment is » Rehearse skills; ability of the assessment, especially when
intended to make the assessment more real- » Know the timing of the OSCE; several assessors are required. This con-
istic (Major, 2005). » Develop skills on clinical placement; sists of the skill broken down into steps,
Filming students’ performance in form- » Revise the underpinning theory of skills; which are marked using a binary rating
ative and summative OSCEs is common » Use feedback from mock/formative (“achieved” or “not achieved”). Tables 1 and
practice. The film can be used to identify OSCEs; 2 contain samples of checklists from a year
areas where students need to improve, or » Use available resources such as guided 1 (level 4) pre-registration nursing OSCE.
by assessors to resolve a query regarding a study, quizzes and videos; The complete OSCE assesses profes-
student’s performance and also as a form » Check whether they should wear sional behaviour, communication, consent,
of moderation. This should take place for uniforms; handwashing, temperature, pulse, respira-
summative OSCEs to avoid any subjec- » Confirm the date, time, venue and tory rate and manual blood pressure. Two
tivity, and external examiners should be allow enough time to get there; lecturers are present, one as the patient
involved in reviewing the content of the » Practise answering questions verbally. (unless an actor is used) and one leading the
stations, checklists and marking criteria. Box 1 contains some practical points for assessment, with both contributing
students during their OSCE. towards the final mark. The student stays in
Student preparation the same room and performs the skills in
Preparation is vital and increases students’ Assessor/role player preparation any order, but must cleanse their hands
confidence in performing skills during the The assessor and patient need clear guide- before and after contact with the patient.
OSCE and in clinical areas (Street and lines about their roles and how much inter- A global rating scale can be used in
Hamilton, 2010). Formative or mock action is allowed with the student – the stu- combination with a checklist or on its own
OSCEs also increase confidence and com- dent must also be made aware of this. (Rushforth, 2007). The scale allows the
petence (Alinier, 2003). The assessor must be totally familiar overall quality of the student’s perfor-
Students preparing for an OSCE should: with and have a good understanding of the mance to be assessed by an experienced
» Be psychologically prepared; marking criteria and guidelines. It is useful and knowledgeable assessor (Rushforth,
» Be familiar with how equipment works; for first-time assessors to observe some 2007). An example of a global rating score
» Know which procedures/guidelines are OSCEs to gain insight into the process. involves the assessor identifying the level
of the skill performance across the range
Table 1. Checklist for professional behaviour “excellent/good/satisfactory/borderline
pass/borderline fail/fail”. A Likert scale of
Criteria Achieved Not achieved “pass-borderline-fail” can be used by the
Behaves in a professional manner consistent with assessor to judge a student’s performance.
professional standards The assessor must have a sound under-
standing of the assessment and the
Performs procedures with due respect to patient
marking tool.
safety, privacy and dignity
Adheres to uniform policy/dress code Student feedback
Introduces self to patient The stressful nature of OSCEs and the
impact an unsuccessful outcome can have
Asks patient whether they prefer to be called Mr/
on students makes early feedback impor-
Mrs/Ms or by first name
tant. However, providing instant or early / Vol 110 Online issue Nursing Times 27.08.14 3

Nursing Practice

Table 2. Checklist for pulse measurement

Activity Criteria Achieved Not achieved
Manual measurement of Checks that the patient’s arm is resting comfortably
the radial pulse Locates the radial pulse and applies the appropriate amount of
pressure to feel the pulse
Examiner’s reading: _____
Counts pulse for 60 seconds, using a watch with a second hand
Student’s reading: _____ Pulse rate accurate
Informs patient of pulse rate and explains whether it is within the
normal range
Records pulse rate on vital signs chart

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